According to the Centers for Disease Control and Prevention, about 75% of office-based physicians have a certified electronic medical record (EMR) system. For the remaining 25% without an EMR system, here are some tips on how to move forward.

Cost is often cited as among the biggest impediments to EMR uptake. estimates 5-year operating costs of an EMR to be $48,000. Cloud-based EMRs have lower upfront costs, but higher annual fees, landing them at about $58,000 over 5 years.

Those costs are dropping gradually, however, according to Amelia Coleman, lead practice management consultant at MBA HealthGroup, headquartered in South Burlington, VT. “The market has changed from the early days when the industry was dominated by a couple of large companies and things like licenses were costly,” she said.

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Although cloud-based vendors may be pricier, Coleman said she typically recommends these vendors to clients. Their products require less hassle with software and hardware and offer good functionality.  Typically included in the cost is a setup fee of about $3,000 to $5,000, though this is sometimes free as part of an overall package. The cost may include training, which Coleman said is a valuable component. The average cost, she said, ranges from about $600 to $750 per provider per month.

“Free” EMR Systems: Something for Nothing?

A search for vendors may turn up “free” EMR systems, but these are not truly no-cost services. These products typically come with free EMR licensing when a practice uses the organization’s billing services. Coleman said these are effective, depending upon your billing needs, and work best in practices that have a small volume of patients and a steady workflow.

Practices should consider whether the billing end meets meaningful use or Physician Quality Reporting System requirements. Coleman said she knows of some good systems that do not meet these metrics.

Practices should ask about the protocol for dealing with patient phone calls and collections.  A vendor might not provide the same level of service a practice is accustomed to if these tasks are currently handled in-house or by another provider.

“Oftentimes, these companies are, at heart, tech companies that have layered on other services,” she said. “A couple hundred dollars saved [on licensing] is moot if the billing service doesn’t allow you to collect all of the money on table,” Coleman said.

EMR Systems With Staying Power

According to the Department of Health and Human Services (HHS), a majority of hospitals use just a handful of vendors for EMRs. The top 5 vendors supplying EMR services to hospitals participating in the 2015 EHR Incentive Programs were: Cerner Corp., Epic Systems Corp., CPSI Inc., Healthland Inc., and Iatric Systems Inc.

HSS found the top 10 vendors own about 60% of market share, but there were 179 total vendors who supplied these services to hospitals in 2015. Though newer vendors might seem more “cutting edge,” Coleman advises her clients to consider what would happen if the startups don’t make it.

“You want to make sure when investing in an EMR [system] that it is going to stick around,” she said. “It is really cumbersome and costly to change once you make that decision; there is a lot of heartache associated with that.”

Vetting the Systems

The best way to know if a system is going to work is through a vetting process. Practices need to get demos from the 2 or 3 products they are most interested in. During those demos, look at all aspects of the product, both on the clinical and practice management sides.

It is important to make sure there are good templates available for a practice’s most common types of visits. Some EMRs specialize in areas like urology, but a practice may be just as satisfied with a general vendor, particularly if the practice is a multi-specialty group.

Next, practices should ask for references from groups similar to theirs and get other physicians’ perspectives. Remember, however, that an EMR is a personal choice based on how practices like to chart.

“It is important to see what others are doing,” Coleman said. “If you get negative feedback, find out why. It may not be an issue in your practice. And if they love it, they may be using differently than you would.”

EMR Contracts

Once you have decided on an EMR system, there are a few things to consider before signing a contract. Some companies offer add-ons and optional features like patient portals, mobile access, and kiosk check-in. The contract should be read carefully to determine which of these makes sense.

There is not always room for negotiating on cost, but it might be worth inquiring about specials. Some vendors offer society membership discounts, and others may have promotions or waive the cost of extras. “They may not always disclose these things upfront, so you should always ask,” Coleman said.

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